That trend will continue from 2015-2023, when health spending will grow at an average of about 6% annually. Spending on physician and clinical services is expected to rise by 3.8% in 2015, and then increase by an average of 6.0% from 2016-2023, CMS projected.

Those figures contrast with estimates for 2013, when health spending grew by a total of 3.6%, including a 3.3% increase in spending on physician and clinical services, said Andrea Sisko, PhD, an economist in the CMS Office of the Actuary, during a briefing sponsored by Health Affairs. The journal published a paper Wednesday detailing the findings.

Even that higher 2014 growth rate, however, "is lower than that experienced over the past few decades," she said.

The slow growth in 2013 -- which marked the fifth consecutive year overall health spending increased by less than 4% -- was "due to the sluggish economic recovery, lower payment rate growth for Medicare due to sequestration and the Affordable Care Act, and continued increases in private healthcare cost-sharing requirements," in part from increased enrollment in high-deductible health plans, according to Sisko.

The slow growth in physician and clinical care spending, in particular, was a result of the slow growth in prices for physician and clinical services, which was the slowest it has been since 2002, said Sean Keehan, senior economist in the Office of the Actuary.

Two of the reasons for that slow price growth were reductions in Medicare reimbursement to providers resulting from sequestration as well as a change in Medicare payment policies for multiple procedures, according to Sisko.

For 2014, spending on physician and clinical services is expected to increase by 5.9% as newly insured patients start taking advantage of their coverage and using more services. In 2015, however, the increase is expected to slow to 3.8%, in part because of cuts in payments to Medicare Advantage plans.

CMS developed its projections using actuarial and economic modeling techniques, Sisko explained, noting that they are produced in accordance with the projected baseline scenario of the 2014 Medicare trustees report.

In that report, the Medicare physician fee schedule rates were projected to grow 0% in 2015 and 0.6% per year, on average, for 2016-2023. The estimate does not include a cut in Medicare physician reimbursement of more than 20% scheduled for next April under the Sustainable Growth Rate formula.

Sisko noted that the effect on health spending of the overall economic picture in the U.S. was an "overarching theme" in the projections. "National health expenditure growth and GDP growth had been [occurring] at similar rates and are expected to do so in 2014 as well, she said. "Health spending tends to respond to changes in economic growth -- with a lag."

As a result, healthcare spending as a percentage of the GDP has been relatively stable, but it is projected to rise from 17.2% in 2012 to 19.3% by 2023.

In addition, the way healthcare spending is distributed isn't expected to change much by 2023 among hospital spending, spending on physician and clinical services, and spending on prescription drugs, according to Sisko.

Other projections in the CMS report included:

Medicare spending, which is expected to grow by 4.2% in 2014, is expected to increase by only 2.5% in 2015, partly due to cuts in Medicare Advantage.

Medicaid spending, which shot up 12.8% in 2014, is expected to grow by 6.7% in 2015. This is partly due to the expected expiration of an increase in Medicaid pay for primary care physicians, Keehan said.

Spending growth for private health insurance is expected to change very little, from an estimated increase of 6.8% in 2014 to 6.9% in 2015.

Out-of-pocket spending is expected to go from a decline of 0.2% in 2014 to an increase of 2.3% in 2015 as a result of people moving from being uninsured -- and paying 100% out-of-pocket -- to being insured.

Spending on prescription drugs was a particular area of volatility. Prescription drug spending grew by only 0.4% in 2012, mainly due to many drugs coming off patent; that did not happen as much in 2013, when estimated growth was 3.3%, Keehan said.

In 2014, "we're expecting higher [prescription drug] use because of the coverage expansions" -- not just by newly insured patients, but also patients who move from less to more generous insurance coverage that may have lower cost-sharing for prescriptions, he said. "Also impacting 2014 and 2015 growth is expensive hepatitis C treatments."

In terms of dollar amounts, overall healthcare spending was expected to increase from an estimated $2.9 trillion in 2013 to $5.2 trillion in 2023.

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